Neighborhood Racial and Economic Segregation and Disparities in Violence During the COVID-19 Pandemic.

Objectives. To describe associations between neighborhood racial and economic segregation and violence during the COVID-19 pandemic. Methods. For 13 US cities, we obtained zip code-level data on 5 violence outcomes from March through July 2018 through 2020. Using negative binomial regressions and marginal contrasts, we estimated differences between quintiles of racial, economic, and racialized economic segregation using the Index of Concentration at the Extremes as a measure of neighborhood privilege (1) in 2020 and (2) relative to 2018 through 2019 (difference-in-differences). Results. In 2020, violence was higher in less-privileged neighborhoods than in the most privileged. For example, if all zip codes were in the least privileged versus most privileged quintile of racialized economic segregation, we estimated 146.2 additional aggravated assaults (95% confidence interval = 112.4, 205.8) per zip code on average across cities. Differences over time in less-privileged zip codes were greater than differences over time in the most privileged for firearm violence, aggravated assault, and homicide. Conclusions. Marginalized communities endure endemically high levels of violence. The events of 2020 exacerbated disparities in several forms of violence. Public Health Implications. To reduce violence and related disparities, immediate and long-term investments in low-income neighborhoods of color are warranted. (Am J Public Health. 2022;112(1):144-153. https://doi.org/10.2105/AJPH.2021.306540).

Autopercepción del estado de salud como indicador de la calidad de vida de los pacientes con deterioro cognitivo en función de su lugar de residencia: domicilio versus centro sociosanitario / Self-perception of health status as an indicator of the quality of life in patients with cognitive dysfunction based on the residence: home care versus nursing home

OBJETIVO: analizar la relación entre las variables sociodemográficas y clínicas en pacientes con deterioro cognitivo en función del lugar de residencia (domicilio familiar frente a instituciones), comparándola con la autopercepción del estado de salud de ambos grupos. MATERIAL Y MÉTODOS: estudio comparativo observacional transversal. La muestra estuvo formada por 71 sujetos, de los cuales 44 recibían cuidado informal en su domicilio y asistían a un centro de día (Valencia, España), y 27 que residían en un centro sociosanitario (Teruel, Valencia), ambos situados en zona rural. Los participantes fueron evaluados mediante el índice de comorbilidad de Charlson, Mini-Mental Test de Folstein (MMSE), test de fluidez verbal, autopercepción del estado de salud mediante escala visual analógica del Euro-Qol y variables sociodemográficas que incluyeron: sexo, edad, nivel de estudios, estado civil y número de hijos. RESULTADOS: los principales resultados apuntan a que pese a que los pacientes que residen en sus hogares tienen un peor estado cognitivo en relación con el MMSE (diferencia de 3,09 puntos; p = 0,003) y la fluidez verbal (diferencia de 3,05 puntos 5,32; p = 0,000), su autopercepción del estado de salud es superior frente a aquellos que viven en un centro sociosanitario (diferencia de 21,22 puntos; p = 0,000). CONCLUSIONES: los sujetos que residen en el domicilio presentan una autopercepción de su estado de salud mejor que aquellos que residen en el centro sociosanitario, pese a que su estado cognitivo muestra peores resultados. Este aspecto contribuye a la mejora de la utilización de los recursos necesarios hacia los ámbitos donde los cuidados sean más eficaces

OBJECTIVE: analyze the relationship between sociodemographic and clinical variables in patients with cognitive impairment regarding to the place of residence (family home versus institutions), compare their self-perception of health status. MATERIAL AND METHOD: observational comparative study. The sample was formed by 71 participants; 44 of them were living in their homes and attended to a day center and 27 of them resided in a Social Health Center. Participants were evaluated using the Charlson comorbidity index, Folstein Mini Mental Test (MMSE), verbal fluency test, self-perception of health status using Euro-Qol visual analogue scale and sociodemographic variables included: sex, age, level of studies, marital status and number of children. RESULTS: the main results suggest that patients residing in their homes have a worse cognitive state compared to those who lived in Social Health Centers in relation to the MMSE (difference of 3,09 points, p = 0,003) and verbal fluency (difference of 3,05 points 5,32, p = 0,000). However, their self-perception of health status was higher (difference of 21,22 points, p = 0,000). CONCLUSIONS: patients with cognitive dysfunction who reside in their homes have a better self-perception of their health status compared to those who reside in the Social Health Center. This aspect is of relevance to the improvement of the development of cost-effective strategies that encourage the health of patients with cognitive diseases

Home and Workplace Neighborhood Socioeconomic Status and Behavior-related Health: A Within-individual Analysis.

BACKGROUND: The influence of individual and home neighborhood socioeconomic status (SES) on health-related behaviors have been widely studied, but the majority of these studies have neglected the possible impact of the workplace neighborhood SES. OBJECTIVE: To examine within-individual associations between home and work place neighborhood SES and health-related behaviors in employed individuals. METHODS: We used participants from the Swedish Longitudinal Occupational Survey of Health who responded to a minimum of two surveys between 2012 and 2018. Data included 12,932 individuals with a total of 35,332 observations. We used fixed-effects analysis with conditional logistic regression to examine within-individual associations of home, workplace, as well as time-weighted home and workplace neighborhood SES index, with self-reported obesity, physical activity, smoking, excessive alcohol consumption, sedentary lifestyle, and disturbed sleep. RESULTS: After adjustment for covariates, participants were more likely to engage in risky alcohol consumption when they worked in a workplace that was located in the highest SES area compared to time when they worked in a workplace that was located in the lowest SES area (adjusted odds ratios 1.98; 95% confidence interval: 1.12 to 3.49). There was an indication of an increased risk of obesity when individuals worked in the highest compared to the time when they worked in the lowest neighborhood SES area (1.71; 1.02-2.87). No associations were observed for the other outcomes. CONCLUSION: These within-individual comparisons suggest that workplace neighborhood SES might have a role in health-related behaviors, particularly alcohol consumption.

Ethnic-minority groups in England and Wales-factors associated with the size and timing of elevated COVID-19 mortality: a retrospective cohort study linking census and death records.

BACKGROUND: We estimated population-level associations between ethnicity and coronavirus disease 2019 (COVID-19) mortality using a newly linked census-based data set and investigated how ethnicity-specific mortality risk evolved during the pandemic. METHODS: We conducted a retrospective cohort study of respondents to the 2011 Census of England and Wales in private households, linked to death registrations and adjusted for emigration (n = 47 872 412). The outcome of interest was death involving COVID-19 between 2 March 2020 and 15 May 2020. We estimated hazard ratios (HRs) for ethnic-minority groups compared with the White population, controlling for individual, household and area characteristics. HRs were estimated on the full outcome period and separately for pre- and post-lockdown periods. RESULTS: In age-adjusted models, people from all ethnic-minority groups were at elevated risk of COVID-19 mortality; the HRs for Black males and females were 3.13 (95% confidence interval: 2.93 to 3.34) and 2.40 (2.20 to 2.61), respectively. However, in fully adjusted models for females, the HRs were close to unity for all ethnic groups except Black [1.29 (1.18 to 1.42)]. For males, the mortality risk remained elevated for the Black [1.76 (1.63 to 1.90)], Bangladeshi/Pakistani [1.35 (1.21 to 1.49)] and Indian [1.30 (1.19 to 1.43)] groups. The HRs decreased after lockdown for all ethnic groups, particularly Black and Bangladeshi/Pakistani females. CONCLUSION: Differences in COVID-19 mortality between ethnic groups were largely attenuated by geographical and socio-demographic factors, though some residual differences remained. Lockdown was associated with reductions in excess mortality risk in ethnic-minority populations, which has implications for a second wave of infection.

County-level Social Vulnerability is Associated With Worse Surgical Outcomes Especially Among Minority Patients.

OBJECTIVE: We sought to characterize the association between patient county-level vulnerability with postoperative outcomes. SUMMARY BACKGROUND DATA: Although the impact of demographic-, clinical- and hospital-level factors on outcomes following surgery have been examined, little is known about the effect of a patient's community of residence on surgical outcomes. METHODS: Individuals who underwent colon resection, coronary artery bypass graft (CABG), lung resection, or lower extremity joint replacement (LEJR) were identified in the 2016 to 2017 Medicare database, which was merged with Center for Disease Control social vulnerability index (SVI) dataset at the beneficiary level of residence. Logistic regression models were utilized to estimate the probability of postoperative complications, mortality, readmission, and expenditures. RESULTS: Among 299,583 Medicare beneficiary beneficiaries who underwent a colectomy (n = 88,778, 29.6%), CABG (n = 109,564, 36.6%), lung resection (n = 30,401, 10.1%), or LEJR (n = 70,840, 23.6%).Mean SVI score was 50.2 (standard deviation: (25.2); minority patients were more likely to reside in highly vulnerable communities (low SVI: n = 3531, 5.8% vs high SVI: n = 7895, 13.3%; P < 0.001). After controlling for competing risk factors, the risk-adjusted probability of a serious complication among patients from a high versus low SVI county was 10% to 20% higher following colectomy [odds ratio (OR) 1.1 95% confidence intervals (CI) 1.1-1.2] or CABG (OR 1.2 95%CI 1.1-1.3), yet there no association of SVI with risk of serious complications following lung resection (OR 1.2 95%CI 1.0-1.3) or LEJR (OR 1.0 95%CI 0.93-1.2). The risk-adjusted probability of 30-day mortality was incrementally higher among patients from high SVI counties following colectomy (OR 1.1 95%CI 1.1-1.3), CABG (OR 1.4, 95%CI 1.2-1.5), and lung resection (OR 1.4 (95%CI 1.1-1.8), yet not LEJR (OR 0.95 95%CI 0.72-1.2). Black/minority patients undergoing a colectomy, CABG, or lung resection who lived in highly socially vulnerable counties had an estimate 28% to 68% increased odds of a serious complication and a 58% to 60% increased odds of 30-day mortality compared with a Black/minority patient from a low socially vulnerable county, as well as a markedly higher risk than White patients (all P > 0.05). CONCLUSIONS: Patients residing in vulnerable communities characterized by a high SVI generally had worse postoperative outcomes. The impact of social vulnerability was most pronounced among Black/minority patients, rather than White individuals. Efforts to ensure equitable surgical outcomes need to focus on both patient-level, as well as community-specific factors.

Appropriate knowledge of the indications for medications in use among older individuals assisted in the Jornada Científica dos Acadêmicos de Farmácia-Bioquímica

This study aimed to identify variables associated with the appropriate recall of indications and the drug classes that represented the most unmatching medications (i.e., when the individual who used it had not reported any illness that matched its indications). Community-dwelling individuals aged ≥60 years using ≥1 medication, from Santa Cruz da Esperança-SP, Brazil, were home-interviewed. Logistic regression models were used to evaluate the association between the appropriate recall of the indications for all medications in use and the following: gender, age, education, individual income, living arrangement, self-perceived health, and medication number, administration, payment, and identification. Medications whose indications were inappropriately recalled were classified as matching or unmatching. One hundred seventeen individuals used an average of 5.1 (standard deviation, 3.3) medications. Sixty-one (52.1%) appropriately recalled all indications. The appropriate recall of all indications was negatively associated with the number of medications in use (e.g., individuals taking 5-6 medications were 25 times less likely to appropriately recall all indications than those taking 1-2). Antithrombotic, acid-related disorder and psychoanaleptic classes showed greater frequencies of unmatching than matching medications. Therefore, counseling the elderly about drug indications should focus on those using ≥3 medications and/or antithrombotic, acid-related disorder, and psychoanaleptic agents.

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults.

Importance: Advance care planning (ACP) is low among older adults with socioeconomic disadvantage. There is a need for tailored community-based approaches to increase ACP, but community patterns of ACP are poorly understood. Objective: To examine the association between neighborhood socioeconomic status (nSES) and ACP and to identify communities with both low nSES and low rates of ACP. Design, Setting, and Participants: This cross-sectional study examined University of California San Francisco electronic health record (EHR) data and place-based data from 9 San Francisco Bay Area counties. Participants were primary care patients aged 65 years or older and living in the San Francisco Bay Area in July 2017. Statistical analysis was performed from May to June 2020. Exposures: Patients' home addresses were geocoded and assigned to US Census tracts. The primary factor, nSES, an index combining area-level measures of income, education, poverty, employment, occupation, and housing or rent values, was divided into quintiles scaled to the distribution of all US Census tracts in the Bay Area (Q1 = lowest nSES). Covariates were from the EHR and included health care use (primary care, outpatient specialty, emergency department, and inpatient encounters in the prior year). Main Outcomes and Measures: ACP was defined as a scanned document (eg, advance directive), ACP Current Procedural Terminology code, or ACP note type in the EHR. Results: There were 13 104 patients included in the cohort-mean (SD) age was 75 (8) years, with 7622 female patients (58.2%), 897 patients (6.8%) identified as Black, 913 (7.0%) as Latinx, 3788 (28.9%) as Asian/Pacific Islander, and 748 (5.7%) as other minority race/ethnicity, and 2393 (18.3%) self-reported that they preferred to speak a non-English language. Of these, 3827 patients (29.2%) had documented ACP. The cohort was distributed across all 5 quintiles of nSES (Q1: 1426 patients [10.9%]; Q2: 1792 patients [13.7%]; Q3: 2408 patients [18.4%]; Q4: 3330 patients [25.4%]; Q5: 4148 patients [31.7%]). Compared with Q5 and after adjusting for health care use, all lower nSES quintiles showed a lower odds of ACP in a graded fashion (Q1: adjusted odds ratio [aOR] = 0.71 [95% CI, 0.61-0.84], Q2: aOR = 0.74 [95% CI, 0.64-0.86], Q3: aOR = 0.81 [95% CI, 0.71-0.93], Q4: aOR = 0.82 [95% CI, 0.72-0.93]. A bivariable map of ACP by nSES allowed identification of 5 neighborhoods with both low nSES and ACP. Conclusions and Relevance: In this study, lower nSES was associated with lower ACP documentation after adjusting for health care use. Using EHR and place-based data, communities of older adults with both low nSES and low ACP were identified. This is a first step in partnering with communities to develop targeted, community-based interventions to meaningfully increase ACP.

Epidemias, virus y activos para la salud del barrio / Epidemics, viruses and neighborhood health assets

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Effect of living arrangement on anthropometric traits in first-year university students from Canada: The GENEiUS study.

BACKGROUND: The transition to university often involves a change in living arrangement for many first-year students. While weight gain during first year of university has been well documented, Canadian literature on the impact of living arrangement within this context is limited. The objective of this investigation was to explore the effect of living arrangement on anthropometric traits in first-year university students from Ontario, Canada. METHODS: 244 first-year undergraduate students were followed longitudinally with data collected early in the academic year and towards the end of the year. Anthropometric parameters including weight, waist and hip circumference, body mass index (BMI), and waist-to-hip ratio (WHR) were examined. The Wilcoxon signed-rank test was used for pairwise comparison of traits from the beginning to end the year in the absence of adjustments. Additionally, linear regression models with covariate adjustments were used to investigate effect of the type of living arrangement (i.e. on-campus, off-campus, or family home) on the aforementioned traits. RESULTS: In the overall sample, a significant weight increase of 1.55kg (95% CI: 1.24-1.86) was observed over the school year (p<0.001), which was also accompanied by significant gains in BMI, and waist and hip circumferences (p<0.001). At baseline, no significant differences were found between people living on-campus, off-campus, and at home with family. Stratified analysis of change by type of living arrangement indicated significant gains across all traits among students living on-campus (p<0.05), and significant gains in weight and BMI among students living at home with family. Additionally, a comparison between living arrangements revealed that students living on campus experienced significantly larger gains in weight and BMI compared to students living off-campus (p<0.05). CONCLUSION: Our findings indicate that living arrangement is associated with different weight gain trajectories in first-year university students.

Mortalidad relacionada con características sociodemográficas y tierra cultivada de los municipios andaluces / Mortality related to sociodemographic characteristics and cultivated land of Andalusian municipalities

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Improved Geocoding of Cancer Registry Addresses in Urban and Rural Oklahoma.

BACKGROUND: Between 1997 and 2013 (the included study years), approximately 23% of addresses in the Oklahoma Central Cancer Registry (OCCR) were not geocoded to the address level. Addresses in rural counties were geocoded with poorer quality, preventing the instructive geographic research that informs policymaking. METHODS: To improve the accuracy of the geocodes, we first utilized the United States Postal Service's LACSLink database to correct addresses; specifically, to convert old rural route-based addresses to modernized Enhanced 911 (E911) addresses. We created custom geocoders using regional E911 reference data sets and used existing national scope geocoders of NAVTEQ and the North American Association of Central Cancer Registries. We attempted to geocode 5,102 addresses, which are either regular street addresses or rural route addresses. In the process, we evaluated and tabulated performances of the address correction. Accordingly, we first tabulated how well each geocoder could geocode original and LACSLink corrected addresses. We then documented the overall performances of geocoders based on pairwise comparisons. RESULTS: We were able to geocode 1,945 addresses out of this data set using 5 distinct geocoders. We observed that the LACSLink correction and E911 data were useful in the specific purpose of geocoding rural addresses, as found in the literature. CONCLUSIONS: We conclude that both LACSLink correction and E911 data were useful for improving geocoding of cancer records, many of which were in rural areas. Future directions include further validation of the geocoding and plans to conduct spatial exploratory data analysis to generate hypotheses related to the distribution of cancer in Oklahoma.

Asociación entre determinantes socioeconómicos y exposición al humo ambiental del tabaco en niños / Association between socioeconomic determinants and environmental tobacco smoke exposure in children

OBJETIVO: Valorar la asociación entre la prevalencia de exposición al humo ambiental del tabaco (HAT) en los niños y niñas españoles y diferentes determinantes socioeconómicos. MÉTODO: Se analizó información de 5495 menores de 15 años incluidos en la Encuesta Nacional de Salud de España 2011-2012. Se realizaron análisis crudos de las variables de interés y se ajustó un modelo de regresión logística multivariante para evaluar la relación de variables socioeconómicas con la exposición al HAT total, en el hogar y en medios de transporte y lugares públicos cerrados. RESULTADOS: La prevalencia de exposición al HAT total en menores de 15 años fue del 11,8%. La odds ratio de la prevalencia (ORP) de exposición en el hogar resultó el doble para los/las mayores de 5 años (ORP: 2,19 para 6-9 años y 2,28 para 10-14 años) que para los/las más pequeños/as. Un nivel de estudios de los progenitores inferior y medio se asoció con mayor exposición (ORP: 1,97 y 1,29), al igual que las clases sociales IV-VI (ORP: 1,42). Una composición del hogar diferente a «pareja con hijos/as» y residir en viviendas más pequeñas también se relacionó con una mayor exposición. Los resultados de exposición total son muy similares a los de exposición en el hogar (11,5%) debido a la baja prevalencia de exposición en medios de transporte y lugares públicos cerrados (0,8%). CONCLUSIÓN: En España, los/las menores de 15 años con peor situación socioeconómica presentan mayor prevalencia de exposición al HAT. Estas desigualdades deben considerarse al establecer y desarrollar estrategias de salud pública

OBJECTIVE: To assess the association between exposure to environmental tobacco smoke (ETS) and different socioeconomic determinants among Spanish children. METHOD: We analyzed the data of 5495 children included in the 2011-2012 Spanish National Health Survey. We estimated the prevalence of exposure to ETS and adjusted logistic regression models to identify variables related to exposure to ETS: total exposure and exposure in the home in addition to ETS exposure in enclosed public places/transport. RESULTS: Total exposure to ETS among children aged 15 and younger was 11.8%, 11.5% of whom were exposed at home and 0.8% in enclosed public places/transport. The prevalence odds ratio (POR) of exposure at home increased with age (6-9 years: 2.19; 10-14 years: 2.28), in children with parents of low or medium education levels (1.97 and 1.29), of social class IV-VI (1.42), among those living in a household with a composition other than a "couple with children" (1.43), and in smaller-sized homes (1.39). Total exposure results were similar to home exposure results. CONCLUSION: The prevalence of ETS is higher among children younger than 15 years with a more difficult economic situation. These inequalities must be considered in the establishment and development of public health policies

Home Language and Literacy Environments and Early Literacy Trajectories of Low-Socioeconomic Status Chilean Children.

This study used Latent Class Analysis to identify groups of children exposed to similar Home Language and Literacy Environments (HLLE) and explored whether belonging to a given HLLE group was related to children's language and early literacy growth from prekindergarten to kindergarten. Participants were 1,425 Chilean mothers and their children (Mage  = 52.52 months at baseline) from low-socioeconomic status households. Four HLLE groups were identified, which were associated with different trajectories of language and early literacy development. Children from groups whose mothers either read and talk about past events with them or teach them letters in addition to reading and talking about past events, showed higher relative vocabulary and letter knowledge. Implications for research and interventions are discussed.

Residential Links to Air Pollution and School Children with Asthma in Vilnius (Population Study).

Background and objectives: Many studies have been carried out on the negative health effects of exposure to PM10, PM 2.5, NO2, CO, SO2 and B[a]P for small populations. The main purpose of this study was to explore the association of air pollution to diagnosis of asthma for the whole huge population of school children between 7-17 years in Vilnius (Lithuania) using geographical information system analysis tools. Material and Methods: In the research, a child population of 51,235 individuals was involved. From this large database, we identified children who had asthma diagnosis J45 (ICD-10 AM). Residential pollution concentrations and proximity to roads and green spaces were obtained using the ArcGIS spatial analysis tool from simulated air pollution maps. Multiple stepwise logistic regression was used to explore the relation between air pollution concentration and proximity between the roads and green spaces where children with asthma were living. Further, we explored the interaction between variables. Results: From 51,235 school children aged 7-17 years, 3065 children had asthma in 2017. We investigated significant associations, such as the likelihood of getting sick with age (odds ratio (OR) = 0.949, p < 0.001), gender (OR = 1.357, p = 0.003), NO2 (OR = 1.013, p = 0.019), distance from the green spaces (OR = 1.327, p = 0.013) and interactions of age × gender (OR = 1.024, p = 0.051). The influence of gender on disease is partly explained by different age dependency slopes for boys and girls. Conclusions: According to our results, younger children are more likely to get sick, more cases appended on the lowest age group from 7 to 10 years (almost half cases (49.2%)) and asthma was respectively nearly twice more common in boys (64.1%) than in girls (35.9%). The risk of asthma is related to a higher concentration of NO2 and residence proximity to green spaces.

Associations between ethnicity, place of residence, hearing status of family and habilitation of children with hearing impairment.

BACKGROUND: Hearing parents tend to have a strong preference for their deaf and hard-of-hearing children to acquire adequate speech, as opposed to use of sign language. Research reports the contribution of many variables to speech acquisition by children with hearing loss (HL). Yet, little is known about the association between ethnicity, place of residence, and hearing status of family members and mode of communication of young people with HL. The purpose of the present study was to examine whether mode of communication of young people with HL is associated with ethnicity, place of residence, and hearing status of family members. METHOD: Participants were young adults with sensory-neural severe to profound HL, either congenital or acquired prior to age 3. Only participants without additional disabilities were included. The data on participants were extracted from records of the Ministry of Labor, Social Affairs and Social Services in Israel. The data for each participant in the study included mode of communication, gender, use of assistive device, ethnicity, geographic place of residence, and presence of first-degree relatives with HL. Regarding participants with a cochlear implant (CI), age at implantation was documented as well. RESULTS: Chi-square tests revealed significant associations between mode of communication and all of the study variables. In addition, all the study variables made a significant contribution to mode of communication. Regarding ethnicity, most of the ultra-Orthodox participants used oral language, while the majority of Israeli-Arab participants used sign language. Regarding geographical place of residence, lower rates of oral language use were found in the northern and southern districts of Israel. CONCLUSIONS: The findings of the present study underline the need for better monitoring of Israeli-Arab children with HL and children residing in peripheral areas in Israel and for improving access to habilitation services.

Does elderly safety matter? Associations between built environments and pedestrian crashes in Seoul, Korea.

Korea's elderly population is growing rapidly, as is attention to elderly pedestrian safety. Despite a consensus that the elderly are vulnerable to pedestrian safety issues, our understanding of the determinants of elderly pedestrian crashes is limited. This study explores which attributes of the built environment affect the risk of pedestrian accidents among the elderly, particularly with respect to injury severity, in Seoul, Korea. We compare the impacts of various determinants on pedestrian crashes to specify how the associations between various built environments and pedestrian accidents differ by pedestrian age. We also examine how the associations vary by neighborhood economic attributes. Our findings provide policy implications for identifying various attributes of the built environment that increase the risk of elderly pedestrian crashes and improving the safety of elderly pedestrian by neighborhood economic status.